Ground Glass vs. Radiation Pneumonitis/Fibrosis?

Portal Forums Cancer Basics Imaging Issues Ground Glass vs. Radiation Pneumonitis/Fibrosis?

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This topic contains 5 replies, has 2 voices, and was last updated by catdander forum moderator catdander forum moderator 1 year, 8 months ago.

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March 22, 2016 at 7:47 pm  #1273361    

pavla

Hello,
My dad was diagnosed with Stage IV NSCLC in Oct 2015. Mutational composition is EGFR Exon 20, MET amplification and p53 gene loss. Our first line of treatment was 10x radiation to bone mets: 7th and 9th left ribs and 2 vertebrae followed by 4 rounds of carboplatin/pemetrexed. He is also on Lovenox for a PE spotted in his left lower lobe.

We just had a CT Scan after the 4 cycles of chemo and all tumors either remained stable or shrank except for an area of ground glass in the left lower lobe, which became larger. Our oncologist believes this is an area of cancer with a likely different mutation, which is why it is not responding to the chemo the same way the other tumor sites (mets in lymph nodes, spine, ribs) are.

The ground glass in the LLL was always mentioned in various ways on past scans. First as a 1.2 cm nodular opacity with “patchy consolidation” on our initial CT scan in October 2015. On our Nov 2015 PET it showed up as 2.5 x 1.5cm with a SUV of 3.1. The radiologist noted re: this area: “relatively low level of subtle increased uptake, likely inflammatory, PE cannot be excluded.” We had a baseline CT done before starting chemo in December 2015 and ground glass in lower left lobe was mentioned but without measurement. On our post-chemo scan last week, the same area was now described as 4.3 x 6.5 cm ground glass with 15 x 8mm nodule, but the radiologist noted, “Development of ground glass adjacent to treated rib lesion consistent with radiation pneumonitits/radiation fibrosis.”

Our current plan is to continue with 3 rounds of Alimta maintenance but figuring out a back up plan (perhaps an immunotherapy trial) in the meantime due to this ground glass situation. The big question is: how can you tell the difference between pneumonitis/radiation fibrosis and progression?

Any insights about this will be much appreciated!
Pavla

March 23, 2016 at 1:02 pm  #1273365    
catdander forum moderator
catdander forum moderator

Hi Pavla,

Welcome to Grace. I’m very sorry about your dad’s diagnosis. It sounds very reasonable that the area in the field of radiation isn’t cancer and is radiation pneumonitis/inflammation. Personally, my husband had inflammation from radiation for months. Unfortunately the only way to tell what it is is time. You mentioned a pulmonary embolism in that area prior to treatment if you feel there is a correlation a question to the oncologist would be appropriate but I’m afraid that isn’t something that could be judged online.

I hope he does well for a long time.
All best,

Janine

March 23, 2016 at 3:37 pm  #1273371    

pavla

Thanks for your kind words, Janine! We’ve asked our oncologist what he thinks of both spots on the scan (PE was in the left lung as well, but I believe in a different spot than the ground glass). We are mentally preparing to accept it’s a sign of progression, but the radiologist’s note on the CT scan about possible fibrosis gave us a case of wishful thinking, so was curious if anyone had similar experiences with groundglass and/or fibrosis.

Thanks again for sharing your insights. Best wishes to you and your husband, I hope he continues to feel well!
Pavla

March 24, 2016 at 1:22 pm  #1273385    
catdander forum moderator
catdander forum moderator

Thanks for the kind regards. Don is going in for his 6 month CT on Monday and I am expecting the best which is my prerogative 3 1/2 years out from treatment but I know from Grace that he’s not out of the woods. It’s never an easy state of affairs but so many multiples smoother than most others in his shoes. Scanxiety is present this week for sure.

If this is a spot within the radiation field then it’s very likely from radiation. Fibrosis is another term for scar tissue in this case from radiation. Ground glass describes the way something looks, hazy not black or white (air in lungs look black on scans solid tissue looks white). In post radiation cases it’s impossible to know what’s going on in the area of lung that was in the field of radiation.

So it’s not at all inappropriate to count on this to represent postradiation inflammation, fibrosis or even a month later radiation still causing damage. Hope for the best but prepare for the worst. It’s a terrible place to be and I hope count on it being nothing.

All best,
Janine

March 24, 2016 at 6:20 pm  #1273389    

pavla

Thank you again, Janine! Your response is hopeful. Our oncologist seems pretty certain it’s a sign of progression, so we’ll just have to wait and see how it turns up in the next scan.

Fingers crossed for you and Don next week, may you get only good news!

Pavla

March 25, 2016 at 12:45 pm  #1273398    
catdander forum moderator
catdander forum moderator

Thanks, you too Pavla!

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